中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2011年
6期
407-412
,共6页
鲍连云%秦勤%向双明%卞征
鮑連雲%秦勤%嚮雙明%卞徵
포련운%진근%향쌍명%변정
角膜移植,深板层%圆锥角膜急性
角膜移植,深闆層%圓錐角膜急性
각막이식,심판층%원추각막급성
corneal transplantation,lamellar%keratoconus,acute hydrops
目的 评价前部深板层角膜移植术治疗急性圆锥角膜的效果.方法 采用临床病例观察方法.分析在南京宁益眼科中心接受前部深板层角膜移植术的急性圆锥角膜5例(5只眼).采用前房注气联合逐步板层分离技术,植床直径7.5～8.0 mm.供体为新鲜和冷冻保存角膜.观察术前和术后1、3、6个月和1年以上裸眼视力、矫正视力、移植片透明性、中央区角膜厚度、中央角膜内皮细胞密度和形态以及排斥反应发生的情况.结果 术前视力:手动/5～10 cm,术后1年平均裸眼视力0.26±0.16,平均最佳矫正视力0.42±0.23;平均球镜度(-2.75±0.94)D,柱镜度(-2.56±0.83)D;术前平均中央角膜厚度(279.33±312.30)μm,术后1年厚度为(557.20±37.48)μm;术前角膜内皮细胞形态和计数不能测量,术后3个月至术后1年内皮细胞数量无明显变化,中央角膜平均内皮细胞计数(1967±228.51)个/mm2;新鲜植片透明性高于保存植片;超声生物显微镜检查:术前病变角膜向前隆起,基质层有囊泡结构,纤维成分减少,回声增强;术后以上改变均消失.术中2眼发生后弹力层微小穿孔,但没改变术式;术后无双前房或排斥反应发生.结论 急性圆锥角膜可不造成角膜内皮细胞数量、形态的严重损害;采用前部深板层角膜移植治疗急性圆锥角膜短期临床效果良好.
目的 評價前部深闆層角膜移植術治療急性圓錐角膜的效果.方法 採用臨床病例觀察方法.分析在南京寧益眼科中心接受前部深闆層角膜移植術的急性圓錐角膜5例(5隻眼).採用前房註氣聯閤逐步闆層分離技術,植床直徑7.5～8.0 mm.供體為新鮮和冷凍保存角膜.觀察術前和術後1、3、6箇月和1年以上裸眼視力、矯正視力、移植片透明性、中央區角膜厚度、中央角膜內皮細胞密度和形態以及排斥反應髮生的情況.結果 術前視力:手動/5～10 cm,術後1年平均裸眼視力0.26±0.16,平均最佳矯正視力0.42±0.23;平均毬鏡度(-2.75±0.94)D,柱鏡度(-2.56±0.83)D;術前平均中央角膜厚度(279.33±312.30)μm,術後1年厚度為(557.20±37.48)μm;術前角膜內皮細胞形態和計數不能測量,術後3箇月至術後1年內皮細胞數量無明顯變化,中央角膜平均內皮細胞計數(1967±228.51)箇/mm2;新鮮植片透明性高于保存植片;超聲生物顯微鏡檢查:術前病變角膜嚮前隆起,基質層有囊泡結構,纖維成分減少,迴聲增彊;術後以上改變均消失.術中2眼髮生後彈力層微小穿孔,但沒改變術式;術後無雙前房或排斥反應髮生.結論 急性圓錐角膜可不造成角膜內皮細胞數量、形態的嚴重損害;採用前部深闆層角膜移植治療急性圓錐角膜短期臨床效果良好.
목적 평개전부심판층각막이식술치료급성원추각막적효과.방법 채용림상병례관찰방법.분석재남경저익안과중심접수전부심판층각막이식술적급성원추각막5례(5지안).채용전방주기연합축보판층분리기술,식상직경7.5～8.0 mm.공체위신선화냉동보존각막.관찰술전화술후1、3、6개월화1년이상라안시력、교정시력、이식편투명성、중앙구각막후도、중앙각막내피세포밀도화형태이급배척반응발생적정황.결과 술전시력:수동/5～10 cm,술후1년평균라안시력0.26±0.16,평균최가교정시력0.42±0.23;평균구경도(-2.75±0.94)D,주경도(-2.56±0.83)D;술전평균중앙각막후도(279.33±312.30)μm,술후1년후도위(557.20±37.48)μm;술전각막내피세포형태화계수불능측량,술후3개월지술후1년내피세포수량무명현변화,중앙각막평균내피세포계수(1967±228.51)개/mm2;신선식편투명성고우보존식편;초성생물현미경검사:술전병변각막향전륭기,기질층유낭포결구,섬유성분감소,회성증강;술후이상개변균소실.술중2안발생후탄력층미소천공,단몰개변술식;술후무쌍전방혹배척반응발생.결론 급성원추각막가불조성각막내피세포수량、형태적엄중손해;채용전부심판층각막이식치료급성원추각막단기림상효과량호.
Objective To evaluate the efficacy of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus acute hydrops. Methods In a prospective, consecutive clinical cases trail. Five keratoconus acute hydrops patients were scheduled for DALK in Nanjing Ning-Yi Eye Center. The donor corneae included fresh and cryopreserved allogeneic bank eyes. Surgerical techniques were air bubble injection to anterior chamber and layer by layer removal of lamellar tissue. The follow-up examinations included visual acuity(VA) , best corrected VA, biomicroscopy, ultrasound pachymetry, specular microscopy, which were measured and recorded at 1,3,6 and over 12 months postoperatively. Results Average VA was HM/5 ～ 10 cm preoperatively, and after operation, average VA was 0.26 ±0.16, mean best corrected VA was 0.42 ±0.23, mean spherical diaopter was ( -2.75 ±0. 94 ) D, mean cylinder diaopter was ( - 2. 56 ± 0. 83) D.Mean central corneal thickness was (279. 33 ±312.30) μm and that was (557. 20 ±37.48) μm at 1 year after operation. The counting of acute hydrop patients' corneal endothelium couldn' t be achieved before surgery. The mean endothelial cell count was (1967 ±228. 51 )/mm2 after surgery. The grafts of fresh corneal donors were better transparent than that of cryopreserved comeae. With ultrasound bio-microscopy technique , acute hydrop corneal anterior surface curvature was higher and there were some small ' cysts' in stromal layer, fabric component part was decreased and had stronger ultrasound echo, but all above pathological phenomena disappeared after operation. All surgeries were uneventful except two patients in whom the Descemet membrane( DM) microperforation occurred. But the pseudo anterior chamber and rejection complications did not occurred and the grafts remained stable at 1 year postoperatively. Conclusions The keratoconus acute hydrops could not cause heavy damage of endothelium and DALK is suitable for acute hydrops.Short-term postoperative outcomes are satisfactory.
